Description
Objective: To evaluate the long-term results and reoperation rate for the failure of arthroscopic all-inside suture repair of ramp lesions of the medial meniscus via a posteromedial approach during anterior cruciate ligament (ACL) reconstruction.
Level of evidence: Level IV, case series.
Methods: All patients who underwent all-inside suture of the posterior segment of the medial meniscus (ramp lesion) via a posteromedial approach during anterior cruciate ligament (ACL) reconstruction at a minimum follow-up of 10 years were included in the study. Side-to-side anterior laxity was assessed preoperatively and postoperatively. Pre- and postoperative functional assessment was based on the subjective IKDC score for activities of daily living and the Tegner activity scale for sporting ability. Reinterventions for meniscal repair failure and other complications were also recorded at the last follow-up.
Results: Eighty-one patients were initially included in the study. Two patients had an ACL graft rupture with a new ramp lesion and were excluded from the analysis. Fifteen patients were lost to follow-up. Sixty-four patients were included in the final analysis. The mean follow-up was 124.8 months (range: 122.4 to 128.4 months). Mean anterior laxity significantly improved from 7.4 mm ± 1.5 (range: 5-12 mm) to 0.4 mm ± 1.3 (range: -3-4 mm) (p < 0.0115). The mean subjective IKDC score increased from 64.3 ± 13.41 (range: 34-92) before the operation to 91.07 ± 12.19 (range: 49-100) at the last follow-up (p<0.0001). The Tegner activity scale score at the last follow-up (6.3 ± 1.6) was lower than that before the trauma (7.1 ± 1.6) (p=0.0198). Fourteen patients (21.9%) had a failed meniscal repair and were reoperated. The mean time from initial repair to reoperation was 64.5 months (range 13 to 126 months), and the median was 60.6 months.
Conclusions: Our results show that arthroscopic repair of ramp lesions of the medial meniscus during ACL reconstruction using a posteromedial approach has a high failure rate at the 10-year follow-up, with half of these suture failures occurring 5 years after the initial repair.
Key words: ACL (anterior cruciate ligament); meniscus; meniscus repair; ramp lesion.
